The public option has gone through several stages of evolution this
year, but it could soon face extinction unless one of the new versions
picks up political momentum.

Senate Democrats have marketed a new “opt-out” public option in recent weeks, and another proposal is expected next week.

{mosads}The proposals have fended off GOP calls for the elimination of the government-run healthcare plan. But it remains to be seen how much life is left in the public option, because no variation has attracted the backing of 60 senators.

Senate Majority Leader Harry Reid (D-Nev.) and his allies are trying to foster that evolution and unite liberals who demand the creation of a government-run public option insurance program with centrists who continue to resist.

Reid proposed a public option with an opt-out clause for states. Liberals grumbled but toed the party line on a procedural vote. Centrists voted yes, but were unmoved from their vow to vote no on the underlying bill.

Sen. Joe Lieberman (I-Conn.) is unyieldingly opposed to any kind of public option. Sen. Blanche Lincoln (D-Ark.) says time and again she won’t support a “government-run, government-funded” insurance program. Sen. Ben Nelson (D-Neb.) says there is room for compromise, maybe on a public option that states could opt into.

Sen. Olympia Snowe (R-Maine) will only consider a public option that serves as an optional fallback if private insurance reforms fail, an idea that Lincoln and Sen. Mary Landrieu (D-La.) say has appeal. Liberals adamantly oppose a fallback/trigger public option.

The high stakes of the debate are almost obscured by esoteric squabbling about triggers, level playing fields and who sets the payment rates. But those disputes continue to be at the heart of the negotiations.

The public option traces its history to the political left’s holy grail for healthcare: the creation of a centralized, government-run, single-payer healthcare system that would replace the private health insurance industry.

Though the single-payer proposal continues to enjoy support within the Democratic Party, leaders from President Barack Obama on down made an early political calculation that it would never pass muster within the diverse ranks of the party’s caucuses in Congress.

Thus, the public option was born: Obama campaigned for the White House promoting the creation of a government insurance program that would be designed to create a stable, nonprofit competitor to private insurers that could drive down costs and serve as a bulwark against industry excesses.

Even that idea has been watered down time and again as Obama, Reid and House Speaker Nancy Pelosi (D-Calif.) have navigated healthcare reform through a tumultuous journey.

The latest version is being devised by centrist Sen. Tom Carper (D-Del.) in consultation with public-option opponents such as Snowe and Landrieu and with public-option supporters like Sen. Charles Schumer (D-N.Y.) and Reid.

The dynamics of this stage of the conversations could be promising: Carper is acting as a go-between to centrists such as Sens. Snowe, Landrieu, Nelson and Lieberman, while Schumer is in constant contact with liberals like Sen. Sherrod Brown (D-Ohio).

Carper’s descriptions of his idea make it sound like it could be all things to all people.

He says his aim is to address criticisms from lawmakers like Lieberman and Sen. Blanche Lincoln (D-Ark.) that the public option is “government-run, government-funded” by putting an outside body in charge and creating a firewall between the program and the Treasury. But this public option would be a national entity, not a collection of state plans, which is a demand of liberals.

“The hammer,” as Carper calls it, shares traits with Snowe’s proposal to trigger a public option in states where private insurers do not meet established benchmarks for availability and affordability. It also jibes with Schumer’s “level-playing field” public option — the version already in the bill — because the plan must be financially self-sustaining. And the plan would be governed by a not-for-profit board, an idea similar to the healthcare cooperatives added to the bill by Sen. Kent Conrad (D-N.D.).